Cardiology quiz 2

  1. what is cariogenic shock
    inadequate oxygen delivery to the body tissues results in shock, which may lead to organ failure and death
  2. what is severe cardiovascular failure caused by?
    • - poor blood flow
    • - inadequate distribution of flow
  3. what are the physical responses of shock mediated by?
    Catecholamines, renin, antidiuretic hormone, glucagon, cortisol, and growth hormone
  4. causes of shock? (4)
    • - hypovolemic shock
    • - cardiogenic shock
    • - obstructive shock
    • - distributive shock
  5. what is hypovolemic shock caused by?
    Hemorrhage, loss of plasma, or loss of fluid and electrolytes resulting in decreased intravascular volume. Obvious loss or “third spacing”
  6. what is cardiogenic shock caused by
    May arise from MI, dysrhythmias, CHF, defects in valve, septum ,HTN, myocarditi
  7. what is obstructive shock caused by?
    Tension pneumothorax, pericardial tamponade, obstructive valvular disease, and PE
  8. what is distributive shock caused by?
    From poorly regulated distribution, IE septic shock, systemic inflammatory response syndrome, anaphylaxis
  9. whats the most common cause of distributive shock? and what is it associated with?
    septic shock, associated with ram negative sepsis in people with extreme age, DM, immunosuppression
  10. Sx of cariogenic shock
    • Cool extremities
    • Weak "thready" distal pulses
    • Altered mental status
    • Diminished urinary output
    • Extremely morbid!! 50% of pts die
    • Hypotension
    • Absence of hypovolemia
    • Poor tissue perfusion: cyanosis, oliguria
  11. Dx of cardiogenic shock
    • - CBC
    • - electrolytes, glucose, urinalysis, and serum creatinine will help determine cause of shock
    • - O2 sat, ABG
    • - EKG
    • - CXR
    • - cardio biomarkers (troponin, BNP)
    • - lactate levels elevated 
  12. tx cardiogenic shock
    • -BLS (airway, breathing, circulation)
    • - Trendelenburg or supine —- blood to the brain!
    • - O2, IV access
    • - Inotropes - dobutamine, epinephrine,
    • - Pressers — dopamine and phenylephrine
    • - Fluid resuscitation — unless pulmonary edema is present!
  13. what is orthostatic hypotension?
    - Insufficient peripheral vasoconstriction in response to orthostatic stress

    • - Defined as: drop in BP within 3 mins of standing (20/10 rule):
    •    - Systolic bp drop >20
    •    - Diastolic bp drop >10
  14. Postural hypotension is a ____ cause of syncope and a significant cause of _____ in the elderly
    • - reversible 
    • -falls
  15. sx orthostatic hypotension
    • - A positional drop in BP between supine, sitting and standing
    •        -If HR increased by 15 bpm of more you should suspect a blood volume issue/cause
    •       - 20/10 rule
    •       - If no change in pulse; consider meds, ANS (parkinsons or peripheral neuropathies)
  16. dx orthostatic hypotension
    • - CBC
    • - CMP
    • - EKG
    • -tilt test
  17. orthostatic hypotension is generally caused by?
    • - Low cardiac output
    • - Cardiac dysrhythimas
    • - Low blood volume
    • - MedsHemorrhage
    • - Excessive diuresis
    • - Addison's disease
    • - GI illness —> excessive puking and diarrhea = syncope
  18. tx of orthostatic hypotension
    • - Fluid
    • - Med change
    • - Monitor
  19. what is vasovagal hypotension?
    • - Abrupt withdrawl of sympathetic tone that increased parasympathetic tone
    • - Main trigger: orthostatic stress (standing), or cough/laugh

    - this is the most common type of neural mediated syncope (NMS)
  20. what are the 3 types of neural mediated syncope (NMS)?
    • 1) vasovagal
    • 2) situational
    • 3) carotid sinus hypersensitivity
  21. Signs of vasovagal hypotension
    • - commonly described using bedzold-jarisch reflex model (entricular mechanoreceptors respond w/ increased discharge-- overshoots as blood is pooling in legs and hands→ kicks off BJ reflex)
    • - heart rate and BP drop together is vasovagal!
  22. sx vasovagal hypotension
    • -nausea, diaphoresis, tachycardia, pallor
    • -aborted by lying down or removing stimulus
  23. dx vasovagal hypotension
    - tilt table
  24. tx vasovagal hypotension
    • -maintaining adequate hydration
    • -avoid predisposing situations
  25. what is endocarditis?
    • - An infection of an endocardial surface of the heart
    • - Uncommon disease with significant morbidity (20% mortality)
  26. endocarditis sx
    • - Fever (may not be present in elderly)
    • - Cough, dyspnea, arthralgias, flank pain and GI symptoms
    • - Stable murmur
    • - Petechiae, splinter hemorrhages, osler nodes, janeway lesions and roth spots  
    • - Pallor and splenomegaly
  27. complications of endocarditis?
    HF, stroke, systemic embolization and sepsis
  28. native valve Endocarditis pathogen
    -strep, staph, enterococci
  29. IV drug user endocarditis pathogens
    staph
  30. prosthetic valve endocarditis pathogen
    • -staph
    • - gram neg. organisms 
    • - fungi
    • - strep in later disease
  31. subacute endocarditis pathogen
    • - strep virdans 
    • - fungi/yeast
  32. endocarditis pathogenesis
    • - The valves do not have blood supply
    • - WBC cannot reach the valves making them prone to infection
    • - Infectious organisms attach to valve surfaces and form vegetations, particularly if the valves are damaged
  33. what are osler nodes
    red raised lesions on hands and feet
  34. what are roth spots
    retinal hemorrhages with white or pale centers
  35. what are janeway lesions
    non-tender!, small, erythematous or hemorrhagic macular or nodular lesions on the palms or soles only a few mm in diameter
  36. acute vs subacute endocarditis
    • acute: 
    •  - symptom onset within 1 wk
    • - shaking chills
    • - high fever
    • - acute malaise
    • - normal gamma globulins
    • - leukocytosis
    • - + rheumatoid fever 

    • subacute: 
    • - symptom onset 4 wks
    • - weight loss
    • - night sweats
    • - elevated gamma globulins
    • - + rheumatoid fever
  37. endocarditis dx
    • - Blood cultures - 3 sets at least 1 hour apart
    • - Echo!! - essential to identify what valve is involved (TEE can be useful)
    • - Cxr -may show cardiac abnormality or pulmonary infiltrates (if right sided heart)
    • - Ekg
    • - Dukes criteria
  38. what is dukes criteria
    • Duke’s criteria!
    • 2 major
    • 1 major + 3 minor
    • 5 minor
    • major
    • 1. 2 positive blood cultures of typical causative agent
    • 2.echocardiogram evidence of endocardial involvement
    • 3.new valvular regurgitation murmur

    • minor
    • 1.Fever over 100.4
    • 2.Vascular phenomena
    • 3.Immunologic phenomena (osler nodes, roth spots)
    • 4.Positive blood cultures not meeting major criteria
  39. endocarditis tx
    - Empiric abx treatment to cover staph,strep and eneterococci. -vanco w/ ceftriaxone

    -If HF: gentamicin, vanco, cefipime

    - Abx prophylaxis in patients with invasive dental work-- amoc, clindamycin, cephalexin or azithromycin if allergic

    -valve replacement (aortic!) if abx fail of for fungal cause.
  40. what is acute pericarditis?
    • - inflammation of the pericardial sac
    • - Disorder involving the pericardium
    • - Idiopathic with presumed viral etiology is most common in USA!
  41. acute pericarditis sx
    • - Chest pain (sharp, dull)
    • - Location - precordial or retrosternal and may be referred to trapezius ridge
    • - Worse with inspiration
    • - Better sitting forward
    • -Viral— pts may note prodrome of symptoms of a viral illness!
    • - Bacterial - pt may have high fever, chills, night sweats and dyspnea
    • - Pericardial friction rub — scratchy
  42. causes of acute pericarditis?
    • - 90% idiopathic or due to viral infection → coxsackie, EBV, paroviris, HIV
    • -also bacterial infection: TB(africa), staph, strep
    • - autoimmune/connective tissue disease, neoplasm, radiation therapy, chemotherapy, drug toxicity , cardiac surgery, tb
    • -common in men younger than 50
    • -causes pericardial effusion (secondary) that causes restrictive pressure on the heart
  43. 2 ways you can get acute pericarditis?
    • - constrictive pericarditis
    • - post MI pericarditis
  44. what is constrictive pericarditis?
    presents with slowly progressive dyspnea, fatigue and weakness accompanied by edema, hepatomegaly and ascites.
  45. what is post MI pericarditis
    (Dressler syndrome) pt will have recurrence of chest pain w/ presence of audible rub
  46. acute pericarditis dx
    • - elevated WBC indicates infection= blood and pericardial fluid cultures!
    • - post - MI pericarditis shows high sedimentation rate (ESR,CRP, troponins)
    • -CXR shows cardiac effusion if 250mL and over
    • -ECG changes ST-segment elevation diffuse!
    • -Doppler ultrasonography, CT and MRI may be helpful for accurate diagnosis before invasive procedure
  47. acute pericarditis tx
    • - if hemodynamic compromise, pericardiocentesis is necessary to relieve fluid accumulation.
    • - If recurrent effusions= pericardial window.
    • - if only inflammatory = NSAIDS
    • - infectious conditions= antibiotic therapy (if bacterial)
    • - pericardiectomy may be performed to relieve constrictive pericarditis
  48. what is cardiac tamponade
    excess fluid in the pericardial sac, leading to compromised ventricular filling and decreased cardiac output
  49. cardiac tamponade sx
    • -dyspnea
    • - Chest discomfort
    • - Unconscious and signs of shock
    • - Tachycardia/tachypnea
    • - More comfortable sitting forward
    • - + friction rub with associated pericarditis
    • - Pulsus paradoxus - abnormally large decline (>10) in systolic artery pressure with inspiration
    • - Jugular venous pressure
    • - The 3 D’s: Distant heart sounds, Distended neck veins, Decreased pulse pressure
    • - Becks triad: Hypotension, Muffled heart sounds, JVD
  50. cardiac tamponade dx
    • - EKG
    • - CXR — small effusions, normal/large effusion - Echo — shows effusion and determines increased intrapericardial pressures
    • - Cardiac cath
  51. common causes of cardiac tamponade
    pericarditis , bleeding into pericardial space after a trauma/surgery
  52. cardiac tamponade tx
    • - Subxiphoid percutaneous pericardiocentesis  - Drainage of pericardial fluid
    • - Complications: puncture RV because of anterior position
  53. what is a pericardial effusion?
    • - secondary to pericarditis, uremia or cardiac trauma.
    • - Produces restrictive pressure on the heart.
    • -frequently w/ lung cancer
  54. pericardial effusion sx
    • - Related to volume of effusion and rapidity of accumulation
    • - None-mild with large volumes that accumulate at slow pace (1-2L usually, accidentally found on CXR)
    • - Severe symptoms with fast collection at smaller volumes - Increased intra-pericardial pressures
    • - Life threatening hemodynamic compromise
  55. large pericardial effusion sx
    • - May compress surrounding structures
    • - Dysphagia
    • - Cough
    • - Hoarseness
    • - Hiccups
    • - Fullness feeling
    • - Nausea
    • - Ewart sign: left lower lobe dullness
  56. small pericardial effusion sx
    • - Cardiac tamponade
    • - Tachycardia
    • - Chest pain
    • - Shock
  57. pericardial effision dx
    • - EKG - small = normal , large = electrical alternans
    • - CXR - large = increased cardiac silhouette
    • - Echo - fastest & most accurate dx in pericardial effusions  
  58. pericardial effusion tx
    - treat underlying cause, pericardiocentesis if effusion is large
  59. essential hypertension
    • - also called primary HTN 
    • - HTN (BP > 140/90)  with no identifiable cause
  60. risk factors for primary/essential HTN
    • - genetic predisposition
    • - high sodium diet
    • - obesity
    • - increased age
    • - blacks
  61. essential HTN sx
    • - asymptomatic, until complications develop
    • - headache
  62. essential HTN dx
    • - urinalysis 
    • - BUN/creatinine, electrolytes 
    • - EKG -- may reveal left ventricular hypertrophy
  63. essential HTN tx
    • - lifestyle modifications: weight loss, exercise, diet, decrease salt intake)
    • - ACEI's, BB, CCBs, diuretics ("ABCD")
  64. secondary HTN
    - HTN due to an identifiable cause
  65. causes of secondary HTN?
    • - renal
    • - endocrine
    • - estrogens, NSAIDS
    • - sleep apnea

    • "CHAPS"
    • - Cushing syndrome, Hyperaldosteroneism, Aortic coactation, Pheochromocytoma, Stenosis of renal arteries
  66. secondary HTN sx
    • - BP > 160/100
    • - asymptomatic
    • - headache
    • - evaluate for end organ damage!
  67. secondary HTN tx
    • - EKG - showing LV hypertrophy
    • - CXR - may show cardiomegaly 
    • - decreased hemoglobin or hematocrit 
    • - urinalysis 
    • - "ABCD"
  68. aortic stenosis is commonly seen in who
    - most often seen in the elderly
  69. aortic stenosis sx
    • - "ACS"
    • Angina, CHF, Syncope
  70. aortic stenosis exam findings
    - pulsus parvus et tardus (weak, delayed carotid upstroke) and a single split S2 sound; systolic murmur radiating to the carotids
  71. aortic stenosis
    • - Harsh systolic ejection crescendo-decrescendo murmur at the right upper sternal border (aortic area) with radiation to the neck and apex heard best by leaning forward with expiration 
    • - often loud with a thrill 
  72. aortic regurgitation, what is it
    - results in the volume overloading caused by the retrograde blood flow into the left ventricle
  73. aortic regurgitation
    • - soft early diastolic blowing murmur along left sternal border with pt sitting leaning forward after exhaling 
    • - high pitch blowing
  74. mitral stenosis, what is it
    - impedes blood flow between right and left atrium
  75. mitral stenosis
    - diastolic low pitched decrescendo rumbling murmur with opening snap heard best at the apex (mitral area) with pt in lateral decubitus position 
  76. mitral regurgitation, what is it
    primarily secondary to rheumatic fever or chordae tendinae rupture after MI
  77. mitral regurgitation
    Holosystolic high-pitched blowing murmur at apex (mitral area) that radiates to axilla with a split S2
  78. Pulmonary stenosis
    harsh, loud, medium pitched systolic murmur heard best at the 2nd/3rd left intercostal space (pulmonic area) that may decrease with inspiration
  79. pulmonary regurgitation (diastolic)
    high pitched, early diastolic decrescendo murmur at the LUSB (pulmonic area) that increases with inspiration 
  80. tricuspid stenosis
    diastolic rumbling murmur at the LLSB (tricuspid area) with an opening snap
  81. tricuspid regurgitation
    high pitched holosostolic murmur at LLSB (tricuspid area) radiates to the sternum and increases with inspiration 
  82. atrial septal defect
    • - Second most common
    • -an opening between the right and left atria. (ostium secundum)
  83. atrial septal defect sx
    • -systolic ejection murmur at 2nd LICS, early to middle systolic rumbe
    • -failure to thrie, fatigability, RV heave, wide fixed split S2
  84. atrial septal defect dx
    ECG, echocardiography, doppler ultrasonography, MRI, chest radiography, radionuclid flow stdies, cardiac catheterization, angiography
  85. atrial septal defect tx
    Early surgical repair.

    - Extracorporeal membrane oxygenation and alprostadil (prostaglandin E) to maintain a patent ductus can be helpful in stabilizing infants w/ cyanotic
  86. contraction of aorta
    systolic LUSB and left interscapular area- may be continuous
  87. contraction of aorta sx
    • - infants may present with CHF, older children may have systolic hypertension or mumur or underdeveloped lower extremities
    • - Differences between arterial pulses and blood pressure in UE and LE pathognomonic
  88. Patent Ductus Arteriosus
    - 12-15% of significant congenital heart disease- higher in pre-mes

    -continuous (machinery) murmur in patients with isolated PDA]
  89. Patent Ductus Arteriosus sx
    -wide pulse pressure, hyperdynamic apical pulse
  90. Tetralogy of Fallot
    -6-10% of significant congenital heart defects

    - Ventricular septal defect, aortic origination over the defect, right ventricular outflow obstruction and right ventricular hypertrophy
  91. Tetralogy of Fallot sx
    - Crescendo-decresendo holosystolic at LSB, radiating to back

    -cyanosis, clubbing, increased RV impulse at LLSB, loud S2

    -polycythemia usually present

    -extreme cyanosis, hyperpnea & agitation = medical emergency
  92. Ventricular Septal Defect
    - Most common

    -systolic murmur at LLSB, others depend on severity of defect
  93. Ventricular Septal Defect
    - Depends on size of defect, asymptomatic to signs of CGF

    -outlet VSDs common in japan and china
Author
Kaylasrice
ID
339918
Card Set
Cardiology quiz 2
Description
cardio wk 2
Updated